This document defines psychotherapy and discusses various types of psychotherapy treatments. It begins by defining psychotherapy as a treatment involving an intimate relationship between client and therapist to explore and modify client behavior. It then discusses several types of psychotherapy including supportive therapy, psychodynamic therapy, behavioral therapy, cognitive-behavioral therapy, group therapy, family therapy, and marital therapy. The document provides details on techniques, indications, and goals for each type of psychotherapy.

1. BEHAVIORAL MEDICINE
PSYCHOTHERAPIES
AND OTHER MODES
OF TREATMENT
Gia Pauline S. Castillo-Mojica, MD, DSBPP, DPCAM, FPPA, FPSMSI, MHA
Raymond Joseph S. Valdez, MD, DSBPP

2. Objectives:
I. Definition of Psychotherapy
II. Discuss Psychosocial Therapy
III. Types of Psychotherapy
IV. Contraindication
V. Unwanted Effects
VI. Supportive Therapy
VII. Psychodynamic/Expressive
VIII. Behavioral Therapies
IX. Biofeedback
X. CBT
XI. Group Therapy
XII. Family Therapy
XIII. Marital Therapy
XIV.Rehab
XV. Milieu

3. ◦“A practice of treatment based on the
development of intimate and therapeutic
relationship between client and therapist for the
purpose of exploring & modifying the client
behavior in satisfying direction.”
Definition: Psychotherapy

4. ◦“A technique which attempts to help the patient
relieve symptoms, resolve problems or seek
personal growth through a structured relation
(i.e. specified goals and methods) with a trained
professional therapist.”
◦The therapist may be a psychiatrist, a
psychologist, a nurse, etc...
Definition: Psychotherapy

5. Goals of Psychosocial Therapy
◦Changing maladaptive behavior pattern.
◦Reducing of environmental conditions that may
be causing such a behavior.
◦Improvement of interpersonal & other
competencies i.e communication skill

6. Goals of Psychosocial Therapy
◦Help the patient to resolve inner conflict &
overcome feelings
◦Change an individual’s accurate assessment of
himself & everyone/everything else
◦Helping him to develop a sense of self-identity

7. Types of Psychotherapy
A. According to Format
◦ 1- Individual therapy.
◦ 2- Group therapy.
◦ 3- Family therapy.
◦ 4- Marital therapy.
◦ 5- Community or Milieu
therapy.
B. According to content
(the applied personality theory)
◦ 1 - Supportive.
◦ 2- Expressive (dynamic or insight
oriented).
◦ 3- Behavioral.
◦ 4- Biofeedback
◦ 5- Cognitive-Behavioral
◦ 6- Experiential (Humanistic approach).
◦ 7- Rehabilitation and activity therapies

8. Contradiction of Psychotherapy
◦Psychotic patient
◦Organic psychosis
◦Unmotivated & unwilling to accept it.
◦Group psychotherapy in hysteria, hypochondriasis etc.
◦Unlikely to respond

9. Unwanted Effects of Psychotherapy
◦Dependent on therapy or therapist.
◦Exacerbation of symptoms
◦Deterioration in relationship.
◦Missed physical treatment
◦Ineffective psychotherapy

10. Supportive Psychotherapy
Definition and Aims
◦It is the type of therapy that deals with conscious
conflicts and current problems.
◦It aims at supporting the patient and helping him to:
1- Relieve symptoms and resolve problems.
2- Regain equilibrium and maintain stability.
3- Achieve better adaptation, coping and functioning.

11. Supportive Psychotherapy
Indications
◦1 - Crisis, acute distress or acute adjustment
disorders.
◦2- Chronic or handicapped patients.
◦3- Patients who are not motivated for deeper
therapy.

12. Techniques of Supportive Psychotherapy
◦ Establishing a therapeutic alliance.
◦ Empathic listening.
◦ Encouragement.
◦ Reassurance
◦ Suggestion, advice and persuasion.
◦ Clarification and explanation (education)

13. Techniques of Supportive Psychotherapy
◦ Strengthening useful defenses.
◦ Suppressing unwanted conflicts.
◦ Help in improve insight
◦ Improving ego strength and functioning
◦ Environmental manipulation and modification.

14. Supportive Psychotherapy
Duration of Psychotherapy
◦Depends on patient's needs,
Format
◦Depends per patient
Complications
◦Mainly dependent on therapist

15. Psychodynamic (Expressive) Therapy
◦A group of deep therapies that aim at symptom
resolution as well as producing positive
fundamental changes in the patient's character
or individuality.

16. Types of Psychodynamic Therapy
◦Psychodynamic psychotherapy includes a
variety) of models:
◦Classical psychoanalysis (of limited use now)
◦Psychoanalytic oriented models
◦Short-term models
◦Object relation
◦Self-psychologv models
◦Etc.

17. Psychodynamic (Expressive) Therapy
◦There is enough ego-strength to tolerate the
experience of change and growth.
◦The patient should also be capable of expressing
his thoughts and emotions.
◦Duration may vary.

18. Psychodynamic (Expressive) Therapy
◦ The short-term techniques are characterized by
being:
1- Time-limited.
2- Problem-focused.

19. Behavioral Therapies
◦This is based on the theory that symptoms are
persistent maladaptive behaviors acquired by
conditioning or learning.

20. Techniques of Behavioral Therapy
1- Systematic desensitization
2- Graded exposure
3- Flooding
4- Aversive conditioning
5- Positive reinforcement
6- Participant modeling

21. Biofeedback
◦ Biofeedback is based on the idea that physiological
functions which are not controlled voluntarily.
◦ It can be brought under voluntary control through
operant conditioning if a person is provided with
feedback information about these functions.

22. Indications of Biofeedback
◦ It is used in the management of a lot of
psychosomatic conditions
◦including hypertension, arrhythmias, migraine,
tension headache, etc.

23. Cognitive-Behavioral Therapy
◦Based on the theory that a person's affect
and behavior are largely caused by the
way in which he cognitively structures and
interprets the world (cognitive schemata
developed from previous experience).
◦automatic thoughts

24. Aim of Cognitive-Behavioral Therapy
◦To identify and correct cognitive distortions
and maladaptive behaviors that result from
them like correcting automatic thoughts.

25. Techniques of CBT
A. Cognitive (verbal) techniques
◦ 1- Identify and test automatic thoughts
◦ 2- Identify and test the underlying postulations or core
beliefs.
◦ 3- Correcting the distorted cognitions and replacing
them with positive and more adaptive cognitive habits.
◦ 4- Rehearsal of the new cognitive and behavioral
responses.

26. Techniques of CBT
B- Behavioral Techniques
◦ 1- Activity scheduling.
◦ 2- Graded task assignment (e.g., graded social activity
to correct social withdrawal).
◦ 3- Rehearsal of new behavior.
◦ 4- Rating of progress in the amount of mastery and
pleasure.
◦ 5- Diversion techniques: e.g., physical activity and
exercise, work, social contact.

27. Characteristic Features of CBT
1- Duration:
◦ Short-term and time limited
◦ usually 15-20 sessions, over 3 months
2- Therapist role:
◦ Active, directive, understanding and empathic
3- Focused on:
a. Conscious aspects of experience and behavior.
b. Present problems.

28. Characteristic Features of CBT
4- Structured:
a. Problems and goals operationally defined.
b. Agenda prepared for each session.
5- Format:
◦ can be used in other formats

29. Indications of CBT
1- Non psychotic Depressive disorders
2- Anxiety disorders
3- Obesity and eating disorders.
4- Substance related disorders

30. Group Therapy
Definition
- A form of therapy in which corrective changes occur as
a result of the interactions of patients with other
patients and at least one trained professional therapist
in a group setting.

31. Group Therapy
Goals
1- Relief of symptoms.
2- Resolution of intrapsychic and interpersonal
difficulties through insight and corrective
experiences.
3- Encouraging personality growth and
development.

32. Group Therapy
Characteristics:
• Size: 6-12 patients (optimum 8).
• Time: 1-2 hours once or twice weekly.
• Duration: months to years

33. Group Therapy
Type of patients:
1. Heterogeneous
2. Homogeneous

34. Group Therapy
Indications
May be used in most disorders except:
•acute manic or Acute psychotic episodes
•antisocial personality disorder

35. Family Therapy
•Family therapy is centered on the idea that the
patient's psychological disturbance reflects a
significant disturbance of his family

36. Family Therapy
•The objective is to help family members gain
insight into their problems and disturbed relational
patterns and change their dysfunctional behavior
and emotions into a healthier pattern.

37. Family Therapy
• The therapy is centered to the family as a whole
rather than the individual patient.
•The family is viewed as a system suffering from
defective functioning resulting from disturbed
rules, roles and relations among its members

38. Marital Therapy
•A form of therapy concerned with unstable
marital couples.
•It aims at resolving interpersonal and related
intrapsychic individual problems of the couple.
•The therapy is focused on the "relationship" rather
than any of the individual partners

39. Rehabilitation
•It is management of disabilities and handicaps
resulting from psychiatric disorder conducted by
trained therapists.
•It is particularly important in long playing
psychiatric disorders (such as chronic
schizophrenia and mood disorders)

40. Rehabilitation
•Aims to improve the patient's performance in
different functional domains including:
1. Personal hygiene and self-care skills.
2. Social and interpersonal skills
3. Vocational and/or educational skills.
4. Recreation and activity therapies

41. Milieu Therapy
•An environment that is designed to assist patients
to:
1. Control and modify problematic (maladaptive)
behaviors.
2. Promote adaptive psychosocial skills in coping
with the self, others and the environment.

42. Milieu Therapy
•The emphasis is on social relationships as well as
occupational and recreational activities.
•To achieve its goals it uses different therapeutic
modalities particularly:
1- Group therapies.
2- Different rehabilitative techniques.
3- Structured activities of daily living for all patients

43. Team involved in Milieu Therapy
Therapy is based on the coordinated work of a
holistic team which includes:
•the psychiatrists
•Psychologists
•psychiatric nursing staff
•social workers
•It also includes occupational, art, play and
recreational therapists

44. View theses videos:
◦ Psychotherapy
https://www.youtube.com/watch?v=OxuZiqY5ypU
◦ The different models (theories) of psychotherapy
https://www.youtube.com/watch?v=vCQNtQA9Lg0

45. Activity:
◦ Discuss the different types of Psychotherapy and list the
indications for each.

46. References:
◦ Kaplan & Sadock’s Synopsis of Psychiatry 11th Edition Copyright 2015
◦ Psychotherapy
https://www.youtube.com/watch?v=OxuZiqY5ypU
◦ The different models (theories) of psychotherapy
https://www.youtube.com/watch?v=vCQNtQA9Lg0

47. THANK YOU
FOR LISTENING!